Nearly four years after the lead-contaminated water began flowing into the homes of residents of Flint, Michigan, the community is still assessing the long-term impact of the damage.

A piece in the Detroit Free Pressreports that Michigan’s bad water is having a significant developmental effect on children and may be contributing to a steep drop in reading proficiency among third graders.

In Flint, third-grade reading proficiency has dropped nearly three quarters in four years, from 41.8 percent to 10.7 percent last year.

Reading proficiency among young students in Michigan has been dropping for years, and fell from 61.3 percent in 2013 to 44 percent last year. While there are several factors at play–including more rigorous standards and a new statewide exam according to Michigan Superintendent of Education Brian Whiston—that still doesn’t explain the extreme drop in Flint.

“I certainly think that some of the (drop in proficiency) could be due to it (lead poisoning). But some of it could be stress. I’m certainly disappointed that it’s at that level,” Whiston told the Detroit Free Press.

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Currently, the state government has no program monitoring the health, development, or behavior of students who have been poisoned by the contaminated water.

As residents continue to grapple with the lasting effects of the water crisis, a study published in the Proceedings of the National Academy of Sciences highlights another deadly impact: the contaminated water was largely responsible for the deadly Legionnaires outbreak in 2014 and 2015 that killed 12 people and infected nearly 100.

Per Buzzfeed, the study, led by Colorado State University associate professor Sammy Zahran, found that residents of Flint “were seven times more likely to get Legionnaires’ than were people in other counties.” After the water source returned to Lake Huron, the risk for the infection reduced to normal levels. BuzzFeed explains the findings:

Chlorine, used by water utilities as a disinfectant, typically keeps bacteria like Legionella at bay. Zahran and his team show that the switch in water supply to the Flint river was followed by major fluctuations in chlorine levels across neighborhoods.

But because authorities failed to add necessary anti-corrosion chemicals after switching to Flint River water, it ate through the pipes, releasing lead and flakes of iron. This brew laid waste to the city’s water infrastructure, but it also reacted with and reduced the chlorine, creating an environment in which Legionella bugs are known to thrive.

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While many researchers in the scientific community lauded the study, the Michigan Department of Health and Human Services issued a response listing its concerns with the research and disputed the findings.

The government, however, has not exactly garnered trust among Flint’s residents. “Many of us have been here waiting on our fairy godfather in the form of a governor to come and save us, riding in on a chariot of government and it’s not going to happen,” Michigan state Rep. Sheldon Neeley, who represents Flint, told the Detroit Free Press. “So everybody has to pick up a piece and overcome these great challenges because they’re just going to grow because we don’t want communities of color to become a part of a permanent underclass.”